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One Hospital (one + hospital)
Selected AbstractsMaternity Nursing: A Delicate Balance: How One Hospital is Getting it RightNURSING FOR WOMENS HEALTH, Issue 6 2007Celeste Phillips R. N. First page of article [source] Clusters of sirenomelia in South AmericaBIRTH DEFECTS RESEARCH, Issue 2 2009Ięda M. Orioli Abstract BACKGROUND One hospital in the city of Cali, Colombia, of the ECLAMC (Latin-American Collaborative Study of Congenital Malformations) network, reported the unusual occurrence of four cases of sirenomelia within a 55-day period. METHODS An ECLAMC routine for cluster evaluation (RUMOR) was followed that included: calculations of observed/expected ratios, site visits, comparison with comprehensively collected local, South American, and worldwide data, cluster analysis, and search for risk factors. RESULTS All four Cali sirenomelia cases were born to mothers living in a 2 km2 area, in neighboring communes, within the municipality of Cali. Considering the total births of the city of Cali as the denominator, and based on ECLAMC baseline birth prevalence rates (per 100,000) for sirenomelia (2.25, 95% CI: 2.66, 3.80), the cluster for this congenital abnormality was unlikely to have occurred by chance (observed/expected ratio = 5.77; 95% CI: 1.57,14.78; p = .002). No consistent common factor was identified, but vicinity to an open landfill as the cause could not be rejected. Another ECLAMC hospital in San Justo, Buenos Aires, Argentina, reported three further cases but these did not seem to constitute a nonrandom cluster. CONCLUSIONS The methodology used to evaluate the two possible clusters of sirenomelia determined that the Cali sirenomelia cluster was unlikely to have occurred by chance whereas the sirenomelia cluster from San Justo seemed to be random. Birth Defects Research (Part A) 2009. © 2008 Wiley-Liss, Inc. [source] Implementation of kangaroo mother care: A randomized trial of two outreach strategiesACTA PAEDIATRICA, Issue 7 2005Robert C Pattinson Abstract Aim: To test whether a well-designed educational package on the implementation of kangaroo mother care (KMC) used on its own can be as effective in implementing KMC in a healthcare facility as the combination of a visiting facilitator used in conjunction with the package. Setting: Thirty-four hospitals in KwaZulu-Natal Province, South Africa. Method: The hospitals were paired with respect to their geographical location and annual number of births at the facility. One hospital in each pair was randomly allocated to receive either the implementation package alone (group A) or the implementation package and visits from a facilitator (group B). Hospitals in group B received three facilitation visits. All hospitals were evaluated by a site visit 8 mo after launching the process and were scored by means of a progress-monitoring tool. Outcomes: Successful implementation was regarded as demonstrating evidence of practice (score>10) during the site visit. Results: Group B scored significantly better than group A (p<0.05). All 17 hospitals in group B demonstrated evidence of practice, with the median score of the group being 15.44 (range 10.29,22.94). Twelve of the hospitals in group A demonstrated evidence of practice and the median score was 11.33 (range 1.08,21.13). Conclusion: Successful implementation was achieved in most of the hospitals irrespective of the strategy used. However, facilitation with an implementation package was clearly superior to using a package alone. Some sites do not need facilitation for successful implementation. [source] From Model to Forecasting: A Multicenter Study in Emergency DepartmentsACADEMIC EMERGENCY MEDICINE, Issue 9 2010Mathias Wargon MD ACADEMIC EMERGENCY MEDICINE 2010; 17:970,978 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, This study investigated whether mathematical models using calendar variables could identify the determinants of emergency department (ED) census over time in geographically close EDs and assessed the performance of long-term forecasts. Methods:, Daily visits in four EDs at academic hospitals in the Paris area were collected from 2004 to 2007. First, a general linear model (GLM) based on calendar variables was used to assess two consecutive periods of 2 years each to create and test the mathematical models. Second, 2007 ED attendance was forecasted, based on a training set of data from 2004 to 2006. These analyses were performed on data sets from each individual ED and in a virtual mega ED, grouping all of the visits. Models and forecast accuracy were evaluated by mean absolute percentage error (MAPE). Results:, The authors recorded 299,743 and 322,510 ED visits for the two periods, 2004,2005 and 2006,2007, respectively. The models accounted for up to 50% of the variations with a MAPE less than 10%. Visit patterns according to weekdays and holidays were different from one hospital to another, without seasonality. Influential factors changed over time within one ED, reducing the accuracy of forecasts. Forecasts led to a MAPE of 5.3% for the four EDs together and from 8.1% to 17.0% for each hospital. Conclusions:, Unexpectedly, in geographically close EDs over short periods of time, calendar determinants of attendance were different. In our setting, models and forecasts are more valuable to predict the combined ED attendance of several hospitals. In similar settings where resources are shared between facilities, these mathematical models could be a valuable tool to anticipate staff needs and site allocation. [source] Does more choice reduce waiting times?HEALTH ECONOMICS, Issue 1 2005Luigi Siciliani Abstract This paper develops a model of the supply of elective treatments within a duopolistic market structure where patients can be referred to the hospital with the lowest waiting times. We investigate the effect of a higher degree of substitutability among the two hospitals on equilibrium supply, waiting time and the size of the waiting list. The degree of substitutability is interpreted as the degree of choice or the extent to which patients can switch from one hospital to the other. We show that the greater the degree of substitutability among hospitals, the lower is the supply and the higher the waiting time. The effect on waiting list size is ambiguous. This result holds either when the hospital is remunerated with a fixed budget or with activity-based funding. However, the reduction in supply and the increase in waiting time generated by higher substitutability are higher when hospitals are remunerated with fixed budgets. The main implication of the model is that, under certain assumptions, policies aimed at increasing provider choice may fail to reduce waiting times. Copyright © 2004 John Wiley & Sons, Ltd. [source] Testing the outcome score of spontaneous intracerebral haemorrhage in haemodialysis patientsINTERNAL MEDICINE JOURNAL, Issue 10 2009B.-R. Huang Abstract The aim of this study is to determine the predictive value of the spontaneous intracerebral haemorrhage (ICH) outcome score (which we described previously) in haemodialysis (HD) patients who develop spontaneous ICH. The validation cohort consisted of all HD patients with spontaneous ICH presenting to Chang Gung Memorial Hospital in Taiwan during 2005,2007. The data were collected from one hospital and prospectively analysed, and the predictive model was tested using an external validation dataset. The prognostic factors were confirmed by chi-squared testing. We calculated the 30-day mortality in different groups of the validation cohort divided according to outcome score and tested the predictive value of the outcome score. The overall mortality rate was 52.6% in 38 HD patients. The originally identified prognostic factors were Glasgow Coma Scale score, age ,70 years, systolic blood pressure <130 or ,200 mmHg, ICH volume ,30 mL, presence of intraventricular haemorrhage and serum glucose ,8.8 mmol/L. All but one (serum glucose ,8.8 mmol/L (P= 0.07)) were subsequently found to be associated with 30-day mortality. In patients scoring 6 and 7, mortality was 100%, but in patients scoring 0, it was only 11.1%. The 30-day mortality in the validation cohort increased steadily with score and had good predictive value (correlation coefficient = 0.986, P < 0.001). Similar results in two different cohorts indicate that the ICH outcome score is a reliable outcome measure. [source] The career paths of a group of Romanian nurses in Italy: a 3-year follow-up studyINTERNATIONAL NURSING REVIEW, Issue 2 2008A. Palese rn, bnsc Purpose:, The objective of this study was to describe for how long a homogeneous group of 17 Romanian nurses who first arrived at the ,Teaching Hospital' in Italy in 2003, stayed in the same hospital/ward of the host country, why and when they decided to move from one hospital to another, and their levels of competence in core skills, after either 6 months or 3 years. Methods:, A longitudinal study design was adopted. The first phase was carried out in 2004, the second in 2006. We used an anonymous questionnaire. Results:, Only ten of the 17 nurses, who had started working in Italy 3 years before, remained in the same Hospital where they first started working. In spite of being given the opportunity to stay, some decided to move to hospitals where it is possible to earn more money or where they could save more by living in less expensive towns. The first nurse left the hospital in the first year, five in the second and one in the third year. Levels of perceived professional independence after 3 years are very good: the permanent group had improved their skills in all areas even though they felt a lack of confidence during the first 6 months. Conclusions:, This study, within the limits of the sample and the methods, shows that foreign nurses are highly mobile in the host country and this revolves around the opportunity to earn more. With increasing recruitment of nurses from within the European continent, it is necessary to continue studying the factors that sustain foreign nurses, to find out how they can be helped, how to value their imported professional skills, how to reduce the initial lack of faith in their own abilities and to discover which strategies would encourage them to stay in the hospital where they arrived. [source] Development and implementation of a noise reduction intervention programme: a pre- and postaudit of three hospital wardsJOURNAL OF CLINICAL NURSING, Issue 23 2009Annette Richardson Aims., By developing, implementing and delivering a noise reduction intervention programme, we aimed to attempt to reduce the high noise levels on inpatient wards. Background., Sleep is essential for human survival and sleep deprivation is detrimental to health and well being. Exposure to noise has been found to disrupt sleep in hospitalised patients which is to be expected as noise levels have been measured and reported as high. Design., A primarily nursing focused, multi-method approach, involving development of clinical guidelines, ward environment review and a staff noise awareness and education programme, was used to target mainly nursing staff plus other healthcare staff on three wards within one hospital. Methods., This practice development initiative was carried out in three key phases (1) Preaudit of ward noise levels, (2) The development, implementation and delivery of a noise reduction intervention programme, (3) Postaudit of ward noise levels. Results., Preintervention average peak decibel levels over 24 hours were found to be 96·48 dB(A) and postintervention average peak decibel levels were measured at 77·52 dB(A), representing an overall significant reduction in noise levels (p < 0·001). Conclusions., This study describes one way to reduce peak noise levels on inpatient hospital wards. Relevance to clinical practice., Sleep deprivation is detrimental to patients with acute illness, so any developments to improve patients' sleep are important. Nurses have a key role in leading, developing and implementing changes to reduce peak noise levels on inpatient wards in hospitals. This nurse-led practice development programme has demonstrated how improvements can be achieved by significantly reducing peak noise levels using simple multi-method change strategies. [source] Universal Health Insurance and the Effect of Cost Containment on Mortality Rates: Strokes and Heart Attacks in JapanJOURNAL OF EMPIRICAL LEGAL STUDIES, Issue 2 2009J. Mark Ramseyer For more than four decades, Japan has offered universal health insurance. Despite the demand subsidy entailed, it has kept costs low by regulatorily capping the amounts it pays doctors, particularly for the most modern and sophisticated procedures. Facing subsidized demand but stringently capped prices on complex procedures, Japanese physicians have had little incentive to invest in specialized expertise. Instead, they have invested in small private clinics and hospitals. The resulting proliferation of primitive clinics and hospitals has cut both the number of complex modern medical procedures performed, and the number of hospitals with any substantial experience in those procedures. With a quarter of the heart disease in the United States, Japan performs less than 3 percent as many coronary bypass operations and less than 6 percent as many angioplasties. Of the 855 cities and regions in Japan, 77 percent lack any hospital with substantial experience in the sophisticated modern treatment (defined below) of cerebrovascular disease, and 89 percent lack much experience in angioplasties. In this article, I estimate one of the costs of this regulatorily-driven lack of expertise. Toward that end, I combine mortality data from 855 cities with information on local hospital expertise and local demographic composition. In the typical city, I find that the addition of one hospital with substantial experience in modern stroke treatment would cut annual stroke mortality by 7 to 16 deaths. The addition of one hospital with substantial experience in angioplasties would cut the annual deaths from heart attacks in the city by over 19. [source] The multidisciplinary approach to mental health crisis management: an Australian exampleJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 1 2004S. WEBSTER rm rpn rgn, cert. public health dip health, master of community health , science (education) Changes within the Australian health care system have led many people with mental health disorders to use emergency departments as the point of access to mental health services. Staff in emergency departments are not necessarily equipped to assess the needs of such clients. This paper briefly describes the development of a multidisciplinary mental health liaison team, within the emergency department of one hospital in Sydney, which was designed to assist both staff and clients. Available evidence suggests the implementation of the team has been a success, however, more research is required to confirm the effectiveness of this approach. Questions are raised about appropriate referral and follow-up for some clients. The study also found deficiencies in the method of routine data collection (Emergency Department Identification System), which makes formal auditing of the team and the services it provides a difficult task. [source] Communication effectiveness of nurses working in a variety of settings within one large university teaching hospital in western JapanNURSING & HEALTH SCIENCES, Issue 4 2002Misae Ito RN Abstract This survey study measured the communication effectiveness of 176 nurses working on a variety of clinical units within one large university hospital in western Japan. The vast majority of the nurses demonstrated fair effectiveness in their communication skills. Although some of the nurses did demonstrate slightly higher communication effectiveness scores, few of the nurses' demographic characteristics appeared to influence how well they communicated. The major limitations of the present study were the use of one hospital for data gathering, and the possible lack of cultural sensitivity of the communication questionnaire. [source] Poor uterine contractility in obese womenBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 3 2007J Zhang Objective, The aim of the study was to elucidate the reason for the high rate of caesarean section in obese women. We examined the following hypotheses: (1) obese women have a high incidence of complications related to poor uterine contractility,caesarean section for dysfunctional labour and postpartum haemorrhage. 2) The myometrium from obese women has less ability to contract in vitro. Design, First, a clinical retrospective analysis of data from 3913 completed singleton pregnancies was performed. Secondly, in a prospective study the force, frequency and intracellular [Ca2+] flux of spontaneously contracting myometrium were related to the maternal body mass index. Setting, Liverpool Women's Hospital and University of Liverpool. Population, The clinical study involved all women who delivered in one hospital in 2002. The in vitro study myometrial biopsies were obtained from 73 women who had elective caesarean section at term. Results, Maternal obesity carried significant risk of caesarean section in labour that was highest for delay in the first stage of labour (OR 3.54). The increased risk of caesarean section in obese women largely occurred in women with normal- and not with high-birthweight infants. Obese women delivering vaginally had increased risk of prolonged first stage of labour and excessive blood loss. Myometrium from obese women contracted with less force and frequency and had less [Ca2+] flux than that from normal-weight women. Conclusions, We suggest that these findings indicate that obesity may impair the ability of the uterus to contract in labour. [source] Central bisectionectomy for centrally located hepatocellular carcinomaBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 8 2008J. G. Lee Background: Central bisectionectomy, which involves the removal of the central hepatic segments (IVA, IVB, V, VIII) for hepatocellular carcinoma (HCC), is performed to reduce the volume of resected liver and to overcome the problem of insufficient future residual volume. Methods: Twenty-seven patients with HCC underwent central bisectionectomy from January 1998 to April 2007 in one hospital. The surgical techniques, clinicopathological characteristics and outcomes were reviewed. Results: The median operating time was 330 min. Twelve patients developed postoperative complications and two died. The most common complication, occurring in five patients, was bile duct injury leading to biloma or bile leakage. Median follow-up was 19·1 (range 1·4,102·2) months and eight patients developed a recurrence. Twenty-four patients were alive at the time of writing. Conclusion: Although biliary complications occur somewhat frequently, central bisectionectomy in centrally located HCC can be performed safely to preserve liver volume. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Scandinavian test of artificial neural network for classification of myocardial perfusion imagesCLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 4 2000Lindahl Artificial neural networks are systems of elementary computing units capable of learning from examples. They have been applied to automated interpretation of myocardial perfusion images and have been shown to perform even better than experienced physicians. It has been shown that physicians interpreting myocardial perfusion images benefit from the advice of such networks. These networks have been developed and validated in the same hospital. However, widespread use of neural networks will only take place if the networks can maintain a high accuracy in other hospitals, i.e. hospitals using different gamma cameras, different acquisition techniques, different study protocols, etc. The purpose of this study was to develop a neural network in one hospital and test it in another. An artificial neural network was trained to detect coronary artery disease using myocardial perfusion scintigrams from 135 patients at a Swedish hospital. Thereafter, this network was tested using scintigrams from 68 patients at a Danish hospital and compared to six criteria based on expert physician analysis and quantitative analysis by the CEqual program. The sensitivity of the network was significantly higher than that of one of the physician criteria (0·92 versus 0·71) and two of the CEqual-based criteria (0·94 versus 0·63 and 0·96 versus 0·65) compared at equal specificities. It was concluded that an artificial neural network can maintain high accuracy in a hospital other than the one where it was developed. [source] | ||||||||||